FROM June 20th, 2020
There are more displaced peoples in Nigeria—over two million—than the populations of Ilorin, Abuja and even Benin City. The scale of this situation in Nigeria is a tragedy for our people and our economy.
At home in Nigeria, the conditions being faced by our population of concern are an increased cause for alarm and focused action within our COVID-19 response strategies – Nigeria is facing immense humanitarian and protection challenges due to the ongoing insurgency in the North East. The conflict has caused grave human rights violations, impacting particularly on the most vulnerable civilians.
According to the UNHCR, as of May 2020, there are 2,046,604 internally displaced persons in the Northeast region, with 90% of the displacements in Borno, Adamawa and Yobe states. Outside of the Northeast an estimated 578,119 people are displaced due to banditry and farmer-herders conflict. There are 61,361 registered refugees and asylum seekers as of April 2020, with 60% located in Cross Rivers, 21% in Taraba, 12% in Benue and 6% registered in Lagos whom are classified as urban refugees and asylum seekers. There are a further 292,513 Nigerian Refugees in our neighbouring countries of Niger (55%), Cameroon (40%), and Chad (5%).
In summary, as of May this year, the total number of people attributed to Nigeria’s existing population of concern stood at 2,107,965. More than 61,000 were registered as refugees and asylum seekers, and the significant remainder originating from neighbouring nations were identified as internally displaced persons (IDP).
The spectrum of challenges that refugees and displaced persons face is very broad: they may be traumatised, having lost homes, livelihoods and identities. However, when the host communities have strong systems in place, the suffering is mitigated, and the road to recovery can begin.
I have always felt that refugees should have health rights guaranteed in any host location, and health-enhanced certifiable identities. The United Kingdom, Greece and Turkey support the health of refugees effectively, with the help of the World Health Organisation, which works closely with government health departments to provide culturally and linguistically sensitive health services to refugees. That’s why in February I was pleased to attend the launch of the Lancet Migration, a collaboration of researchers in migration and health who are building evidence to drive policy change in this area.
I’ve been involved with helping to provide aid to many refugee camps in Northern Nigeria, and I’ve come to the understanding that ensuring health care should be standard in supporting the dignity of displaced persona.
On World Refugee Day today, I commit to working with Lancet Migration, and call for attention on the rights of refugees in relation to accessibility to health care.
FROM June 1st, 2020
This year marked the start of the United Nations’ Decade of Delivery, where we were promised that things would change for the empowerment of women and girls. Armed with research to prove how much better off our world would be with the rights of women and girls realised, we in the global advocacy community declared that it is well past time to start living in a gender equal reality.
Vera Uwaila “Uwa” Omozuwa was a 22-year-old student at the University of Benin who went to her church to read in a quiet space when she was brutally raped. The viral photos of her bludgeoned body have reverberated around the world, adding fire to the flames of the conversation about brutality, violence and lack of a framework for social justice and responsibility; she died of her injuries on 30 May.
In Lagos, 16-year-old Tina Ezekwe was trying to get on a bus when a drunken, corrupt police officer attempted to bribe the driver, leading to a sloppy confrontation and shots fired: the bullet pierced through the upper left side of her lap. The battle to save her life lasted for two days, and she died on 28 May.
In 2018, promising young girls Anita Akapson and Linda Angela Agwetu were murdered in similar, senseless fashion, again by trigger-happy officers around their own homes. These cases spotlight what has been blindingly evident since the forced abductions of the Chibok and Dapchi Schoolgirls: we are failing our women and girls.
Last year I was honoured to join the International Conference on Population and Development, full of hope to deepen Nigeria’s consultations on gender. I called to build political commitment from leaders and policymakers to speak out, condemning violence against women. But with the heartless, thoughtless violent deaths of Uwa and Tina it is clear that we have thus far failed to engage leaders and policymakers to implement meaningful mechanisms to protect them.
I had declared in 2018, after the death of another innocent girl victim of sexual and gender based violence, Ochanya, that we were standing on a gender precipice from where good actions could flow, if together, we determinedly took the right actions to protect women and girls.
I declared that I envisaged a world where everyone can decide freely when to have children, and has the information, education and means to do so. With sexual and reproductive health care deemed “non-essential” during the COVID-19 pandemic, and consequent restrictions implemented all over the world, we have failed to protect women’s rights to her own body.
At the United Kingdom-France consultations on the Prevention of Sexual Violence Initiative last year, we said with such hope that we would uphold the United Nations Security Council’s Resolution 1325 on women peace and security. While at the African Women Leadership Network and the African Union with UNWomen last year, we vowed to invest in women’s groups, to ensure that we give women the leadership opportunities to better shape their own futures, and we did. But when globally, only 1% of gender equality funding is going to women’s groups, we have failed to invest in women.
At the Commonwealth of Nations last year, we made a promise of No More Violence, yet, here we are, from our leaders, and right down to our grassroots, failing women and girls. Frankly, I am outraged. The gruesome deaths of Uwa and Tina are a visceral notice of our failure in Nigeria, and that’s why I am joining the WACOL Tamar SARC and Social Intervention Advocacy Foundation to call for radical reform of our police, to end the impunity of sexual violence against women and girls. In the name of all our global and national commitments to women and girls, the Nigerian state must make systemic changes to protect our young girls. Uwa and Tina’s lives will not be lost in vain.
FROM May 29th, 2020
The recent stories about violent police killings of African Americans are pulling at my heartstrings.
My expertise is in child and maternal health and wellbeing in Africa, and police brutality in the United States may seem like it is 6,218 miles (the distance from Lagos to Minneapolis) away from my wheelhouse. But that would be denying the reality that we Africans are a global community united by the colour of our skin and ancestries that have been altered by systems of oppression that have spanned and scrambled our societies for generations, and which we have, collectively and individually, climbed to overcome.
The video of George Floyd, pleading for his life from under the knee of a casual police officer; the story about the EMT nurse Breonna Taylor, shot a shocking eight times after a misunderstanding; that Ahmaud Arbery was practically hunted by mistaken neighbours while out for a jog is a stark reminder of our peoples’ endangerment.
With all of its power and functioning bureaucracies, the U.S. —held up as the pillar of democratic practice globally—has the means, the wherewithal, and the opportunity to signal to the world that it values black lives. I am given an ounce of relief in the fact that the U.S. Justice Department said it would make a federal investigation into Mr. Floyd’s death a “top priority.” However more must be done through education, investment and empowerment.
In the face of mounting police brutality in my own country, in 2019, I encouraged the youth-led END SARS Movement in Nigeria, initiated by the Social Intervention Advocacy Foundation. Their aim was to establish much-needed partnerships between the key security agencies, academia and industry practitioners for research-based solutions. They have advocated for operational and governance models to be developed—to put a stop to extrajudicial killings of young people.
Since then, some best practices have been adopted and shared, as well as SIAF joining a national security cooperation in support of peace and stability. The work continues as they liaise with national government security agencies and to facilitate them in improving operational standards and good governance, and as they help to maintain a peaceful and tranquil society.
Riots are not an answer – to enable change, stakeholders know that they must constantly undertake methodical studies of endemic and emergent problems in the principles and practices of law enforcement policing, intelligence operations, maintaining homeland security, transnational security and trafficking, corruption and the criminal justice system and promotion of science and technology. Reformation in correctional services and forensic sciences, being an integral part of the justice system, must also be researched thoroughly.
We as Africans and African diaspora must work to instil the understanding that soft phrases such as ‘race relations’ oftentimes hide the fact that racism for so many of us is corporal. The failure of health systems to protect and cure people of black and minority ethnicities around the world means that racism does manifest through organ failure via COVID-19. The failure of police hierarchies to ensure its ranks are careful, and the failure of education systems to teach its pupils about other cultures is manifested through bodies bleeding out from gunshots. Some are calling for African leaders to summon their local US ambassadors to speak out against these injustices, and in the name of our community, I join in that call. We must unite our global African community around these lost souls, who have been killed extra-judicially, to proclaim the might and meaning of human rights and social significance of our people.
FROM May 26th, 2020
As we mark Africa Day, I am encouraged by the milestones we have achieved, standing together as one united Africa, towards providing equity in health access since the Alma Ata declaration of 1978.
Personally, a high point for Nigeria was in 2018 when Nigeria’s National Assembly, chaired by my husband H.E. Dr Bukola Saraki MBBS, CON, helped establish the Basic Health Care Provision Fund. It was a key and catalytic step towards achieving Universal Health Coverage for our citizens.
As the coronavirus pandemic puts health systems to unprecedented tests, I call on our African leaders, of governments, of policies, and of innovative actions, to rise to the challenge of the #AfricaWeWant. We must accelerate investments and actions to meet the health needs of our citizens by strengthening primary health care services with efficient diagnostics, referrals and treatment. Let’s walk the talk for primary health care and wellbeing.
As we stand together in rallying the right resources to combat COVID-19, I also call for the reinforcement and replenishment of the 2001 Abuja Declaration—a pledge made by the African Union, standing as one, promising to increase their health budget to at least 15% of the state’s annual budget. The World Health Organisation reported in 2010 that only one African country had reached that target. Today in 2020, we must replenish and reinforce those promises to ensure that every citizen can access an efficient system of quality health.
FROM May 20th, 2020
During a normal year I would be traveling to the World Health Assembly this week, but this year I joined state leaders and world-renowned experts virtually from our homes, in light of the COVID-19 pandemic. Still, the spirit is evident: global collaboration on the state of our world’s health has never in our lifetime been more necessary.
This is backed by the decades I have worked on maternal, child and family health throughout Nigeria. Primary Health Centres (PHCs) are mostly located within communities, and much of Nigeria and Africa remains rural. With the majority of Nigeria’s population living in these rural communities, and a recognition of the strong indications of community transmission of the virus, PHCs should serve as an important link in the management of the COVID-19. In 2015, I successfully facilitated a maternity referral standard primary health centre at Eruku Cottage Hospital in Kwara State, and saw the benefits of a prompt pathway from diagnostics to treatment and care.
Similarly, from my leadership role chairing Nigeria’s Civil Society Coalition’s Primary Health Care Revitalization Support Group to the 8th National Assembly, which successfully advocated for the Basic Health Care Provision Fund, I know that achieving universal health coverage will not rest upon one single static action, but on the spectrum of interventions and initiatives; from water, sanitation and hygiene standards in healthcare facilities to breastfeeding education and training for healthcare workers.
In a country as large as Nigeria, resilience throughout the whole nation’s system was always going to be necessary if we were going to be able to tackle critical health emergencies in fragile settings, such as in the North East. Today, even the strongest regions are sorely tested, and that is why a strengthened primary health care system is imperative as the foundation to achieve health for all. Support for PHCs should be a focal point for investment, as we coordinate our responses to the pandemic.
It is only by strengthening capacity and concrete frameworks at primary levels of care and education services that we can build the resilience to cope in times of crisis, restore health and prosperity, create healthy futures and improve the wellbeing of citizens in the long-term.
Read more on Wellbeing Foundation Africa>>
FROM May 8th, 2020
I am excited to announce that Wellbeing Foundation Africa is partnering with U.S.-based company Fortify to address iron deficiency: the major underlying cause of maternal deaths during childbirth in developing countries.
I started working on improving iron deficiency in Nigeria in 2014 with a programme called Green Food Steps. I worked with Unilever’s biggest brand Knorr to educate women and daughters to practice new, nutritious cooking habits.
But when I met the Fortify team to talk about a partnership last year, I was struck by how elegant yet practical a solution they have for iron deficiency anemia: they help add iron to ingredients that make up everyday meals—such as tomato paste. Tomato paste is already built into the food supply, it’s a big part of the meals every African eats; that’s why they’ve worked to produce 20 million sachets of iron-fortified tomato paste varieties in Nigeria monthly.
Implementing more iron in our food staples is not just a compassionate move to improve maternal health: it’s economically beneficial, too. According to the World Health Organization, timely treatment of iron deficiency anemia can ultimately raise national productivity levels by as much as 20%.
That’s why I’m so excited to engage First Ladies and women leaders—because of the impact they bring to women, families and communities in improving maternal health outcomes—but also policymakers across Africa to accelerate efforts to eradicate iron deficiency.
Read more on Wellbeing Africa.
FROM May 4th, 2020
Toyin Saraki has hailed International Day of the Midwife, marked today around the globe, as “the most momentous day in a century for midwives.” Saraki, who is Global Goodwill Ambassador for the International Confederation of Midwives (ICM) and Founder-President of the Wellbeing Foundation Africa (WBFA), has marked the day by paying tribute to midwives around the world and by launching a new campaign to improve the safety of their working conditions.
Saraki commented: “2020’s International Day of The Midwife is remarkable in many respects – and is truly momentous, as it takes place in the first ever Year of the Nurse and the Midwife. This year has been designated by the World Health Organization as a year-long effort to celebrate the work of midwives and their colleagues, highlight the challenging conditions they often face, and advocate for increased investments in the workforce.”
“While we celebrate the work of midwives, this is also a solemn day, as we pay tribute to midwives who have lost their lives in the course of their duties, not only during the current COVID-19 crisis but also those in recent years who have paid the ultimate price in conflict areas. Whatever the circumstances, however dangerous, midwives continue to provide a continuum of care, standing beside women at their most vulnerable moments. I know that I will have many midwives, including close friends, in my prayers today.”
“Infection prevention and control is at the top of the global agenda right now. Midwives have led on this since 1840 – if not before – when physician Ignaz Semmelweis worked with midwives to promote water, sanitation and hygiene (WASH) on maternity wards. I am therefore proud today to launch the ‘We Must Applaud Midwives with WASH’ campaign, to highlight that whilst we should applaud midwives we also need to ensure that they have the conditions they need to work safely and deliver for women, babies and communities. WASH plays a vital role in stopping disease transmission yet two out of five healthcare facilities still lack hand hygiene facilities at points of care. I am promoting ten immediate actions which should take place in all healthcare facilities to respond to COVID-19 and protect midwives, their colleagues and patients.”
“Midwives are champions of women’s rights; but can only be effective if their rights are also secure. This includes the right for every midwife—and all health workers—to decent work and a safe and dignified workplace. Saving lives does not mean a midwife should risk her own. I continue to advocate for whole-system support, which means providing midwives with
the adequate tools, equipment, and medicine to provide the full scope of timely, high-quality care, and the capacity to carry out the WHO-recommended 8 antenatal visits. We should all take up the call of the International Confederation of Midwives to celebrate, demonstrate, mobilise and unite with midwives.”
Toyin Saraki is also Special Advisor to the World Health Organization Independent Advisory Group to the Regional Office for Africa, a member of the Concordia Leadership Council and was named by Devex as ‘Global Health for All Champion.
Toyin Saraki is promoting the following ten Immediate WASH Actions in Healthcare facilities to Respond to COVID-19:
1. Handwashing: Set up handwashing facilities, like a bucket with a tap with soap, throughout the facility. Prioritise the facility entrance, points of care and toilets, as well as patient waiting areas (and other places where patients congregate). If the facility is piped, repair any broken taps, sinks or pipes.
2. Water Storage: Consider the water requirements to perform WASH/IPC activities with an increased patient load. If inconsistent or inadequate water supply is a concern, increase the water storage capacity of the facility, such as by installing 10,000L plastic storage tanks.
3. Supplies: Solidify supply chains for consumable resources, including: soap (bar or liquid), drying towels, hand sanitiser and disinfectant. Ensure cleaners have Personal Protective Equipment (PPE) for cleaning. If ingredients are available locally, produce hand sanitiser at the facility (or at district-level) – see WHO protocols.
4. Cleaning & Disinfecting: Review daily protocols, verifying based on national guidelines or global recommendations for resource-limited settings and noting additional levels and frequency of cleaning in clinical areas with high numbers of COVID-19 cases, including terminal cleaning. Ensure adequate supplies of cleaning fluids and equipment, making allowance for additional cleaning requirements. Ensure handwashing stations and toilet facilities are cleaned frequently.
5. Healthcare Waste Management: Strengthen healthcare waste management protocols by making sure bins are located at all points of care, that they are routinely emptied, and waste is stored safely.
6. Staff Focal Points: Assign staff member(s) – cleaners, maintenance staff, or clinicians — whose job it is to oversee WASH at the facility, including: refilling handwashing stations, auditing availability of supplies in wards, reporting on WASH maintenance issues,
monitoring cleaning and handwashing behaviours of staff and communicating updates to the director daily.
7. Training: Organise training for all staff on WASH as it relates to their role at the facility, including a specific training for cleaners based on the protocols reviewed above.
8. Daily Reminders: Remind staff of WASH protocols during morning meetings. Post hygiene promotion materials throughout the facility, particularly next to handwashing facilities.
9. Hygiene Culture: Encourage a culture of hygiene at the facility. Emphasise that all staff members, including cleaners and maintenance staff, are part of a team working to prevent the spread of infection. Recognise individual WASH champions in the HCF.
10. IPC Team: Work with the Infection Prevention and Control (IPC) team at the facility to make sure efforts are reinforced and aligned, avoiding duplication. Encourage WASH focal points/partners to participate in IPC meetings. Coordinate WASH/IPC activities based on plans to isolate COVID-19 patients. More on International Day of the Midwife can be
FROM April 28th, 2020
Together, we are facing a global health crisis. Each day, as the death toll due to COVID-19 rises, people in governments, institutions, hospitals, communities and households around the world are having to navigate unprecedented sacrifice and hardship – making decisions with profound effects on their lives and livelihoods. As a collective network of girls, women, advocates, and allies working in global development, we stand together to encourage global collaboration to combat COVID-19.
Only by working together can we ensure that no one is left behind in our response to the pandemic. Our focus now must be on supporting vulnerable communities and the most vulnerable people within our communities – in the spirit of solidarity, but also for our own protection. This includes girls and women who are now at a higher risk of gender-based violence and rights abuses, and at-risk groups (including people who have disabilities or identify as LGBTQIA) who are being targeted or are unable to access routine services. At a time of ever-increasing social distancing, there has never been a more crucial need for community and selfless leadership. The World Health Organization’s continued focus on saving lives and supporting and protecting the most vulnerable of us will play a pivotal role in our recovery. Now more than ever, countries need to unite behind a strong WHO – sharing knowledge, strategy, technical resources and financial investment to defeat the global threat we all face. We must make no concessions for blame, politicisation or racism in developing an inclusive and effective solution to this crisis.
Across the world, we see the power of community and shared resources, as individuals step forward to support each other. Our heroes – the predominantly-female health workforce, working day and night to serve our communities and unite us – have demonstrated that cooperation is to mitigate the impact of COVID-19. In such challenging times, it is crucial that we overcome any efforts to divide us.
FROM April 15th, 2020
Whenever a high-profile health emergency breaks out or an influential commission needs experts, it seems global health reverts to the default of delivered by women, led by men. The message seems to be Health emergency! Step aside, ladies – men coming through. Although women make up 70 percent of the global health workforce, and although they work at all levels in health security—from the front lines of healthcare, to research labs, to health policy circles – they have not been represented equally in decision-making bodies that are informing our COVID-19 responses.
A presidential tweet showed the first iteration of the U.S. Coronavirus Task Force was composed entirely of men. In January, just five women were invited to join the twenty-one member WHO Emergency Committee on the novel coronavirus.
Unrelated to this decision, UN Secretary General Antonio Guterres made a strong public statement a few weeks later. “Women’s inequality should shame us all. Because it is not only unacceptable; it is stupid,” Guterres said in February. “Only through the equal participation of women can we benefit from the intelligence, expertise and insights of all of humanity.”
FROM April 15th, 2020
The world is hurting, and we need the WHO now more than ever before.
Millions are suffering and misinformation is spreading, with fear and even racism impeding mechanisms for an effective response.
Countries and communities are acting both together and apart. Right now, every community needs information based strictly in science and supported with the benefit of a global perspective. The world needs a well-functioning global organization designed to facilitate international coordination. We need the WHO, our standard-bearer in unprecedented times for an unprecedented virus.
The pandemic is a stark reminder that humans are connected, and that what happens in one country can impact the everyday lives, social fabrics and economies of countries far away. Human connectivity holds power: the positive impact of our collective will to physically distance from one another alone shows what power we hold. Guided by the heart beat of world health—the WHO—together we have pulled resources, research, and we have made a global effort to benefit the health of all of us.
We are grateful for those who have recovered due to the efforts of indefatigable health workers who have detected, tracked, traced and treated the affected, even as we have mourned the lives and livelihoods that we have lost. Together we must continue to marshal support to combat this virus. We hold the hope for better days ahead.
FROM March 25th, 2020
World Tuberculosis Day 2020 – It Is Crucial To Deepen TB Advocacy And Actions To Ensure Tuberculosis Does Not Become Totally Invisible During The COVID-19 Pandemic – Toyin Saraki, Founder, Wellbeing Foundation Africa
I was recently following the research findings of Madhukar Pai, Canada Research Chair of Epidemiology and Global Health at McGill University, Montreal Canada, where he called for a damage control plan for tuberculosis during the ongoing COVID-19 Pandemic. As the coronavirus COVID-19 pandemic sweeps the world, the global health community working to fight TB have growing anxiety about what this pandemic will do to a much older infectious killer – tuberculosis (TB).
We know from the Ebola experience that epidemics can disrupt even basic services such as routine immunization. No doubt, COVID-19 will adversely affect all routine health services everywhere. But TB services is might be one of the biggest casualties. Why? Even before COVID-19, TB had a notorious track record as a ‘Captain of the Men of Death’. TB kills 4000 people each day, and 1.5 million people each year. TB is the leading killer of people living with HIV/AIDS. An estimated 10 million people developed TB in 2018, and nearly half a million people developed drug-resistant TB (DR-TB).
COVID-19 is a crisis of social solidarity and social investment. This applies to TB as well. It is crucial to deepen TB advocacy and actions to make sure TB does not become completely invisible during the COVID-19 pandemic. People are leaving no stone unturned to stop the coronavirus pandemic. If we show even half of this dedication towards ending TB, we can stop millions from dying from a preventable and curable disease.
I stand in solidarity with the Stop TB community as we support people affected by COVID-19. This World TB Day we support the fight against the new pandemic, share our lessons, experiences and tools so that united we can defeat it. We want to remind global leaders the urgency to invest in better and more resilient health systems, today more than ever we realise the need to end endemics like TB or COVID-19. To fight COVID19, we can use the tools needed to End TB: infection control, artificial intelligence, x-rays, contact tracing, telemedicine and psycho-social support.
Years of under-investment made tuberculosis and its drug resistant forms the biggest infectious disease killer with over 4000 deaths per day. We can’t afford to repeat these mistakes and be unprepared for pandemics like COVID19. Most TB survivors have gone through the isolation, fear, discrimination and stigma that we are facing with COVID 19. Let’s hear their voices and learn resilience from them. It’s Time To End TB. It’s time to recognize that people with #TB are vulnerable to COVID19, including prisoners, migrants, people living with #HIV, and those who are malnourished.
Healthcare workers are at the centre of the fight against diseases such as tuberculosis or COVID-19 – While most of us are at home, social distancing, the health workers leave their houses and families to ensure that people with TB get diagnosed, treated and cured and also battle COVID-19. I appreciate and applaud their efforts as frontline health heroes.
I join the Stop TB Partnership in calling on global leaders to join forces to protect people affected by TB and especially vulnerable populations from #COVID19. It’s time to ensure we #LeaveNoOneBehind #ItsTimeToEndTB
FROM February 9th, 2020
Along with the global health community, The Wellbeing Foundation Africa has taken note of the WHO declaration of a public health emergency of international concern over the global outbreak of the Novel Coronavirus.
WHO has identified 13 top priority countries (Algeria, Angola, Cote d’Ivoire, the Democratic Republic of the Congo, Ethiopia, Ghana, Kenya, Mauritius, Nigeria, South Africa, Tanzania, Uganda, and Zambia) which either have direct links or a high volume of travel to China.
“To ensure rapid detection of the novel coronavirus, it is important to have laboratories which can test samples and WHO is supporting countries to improve their testing capacity. Since this is a new virus, there are currently only two referral laboratories in the African region which have the reagents needed to conduct such tests.”
“However, reagent kits are being shipped to more than 20 other countries in the region, so diagnostic capacity is expected to increase over the coming days. Active screening at airports has been established in a majority of these countries and while they will be WHO first areas of focus, the organization will support all countries in the region in their preparation efforts”
“It is critical that countries step up their readiness and in particular put in place effective screening mechanisms at airports and other major points of entry to ensure that the first cases are detected quickly”
The Wellbeing Foundation Africa commends and thanks the thousands of courageous frontline heroes, the frontline health professionals who are working around the clock in affected regions to treat the sick, save lives and bring this outbreak under control. The Wellbeing Foundation Africa continues to advocate and urge, particularly in Nigeria which is currently responding to a Lassa Fever outbreak in over 11 states, that investment in a skilled and sustainable, locally led frontline health workforce able to detect, report and respond to threats and deliver quality health services including water, sanitation and hygiene essentials for infection prevention and control, is crucial to building health systems resilient to outbreak.